Background: The optimal management of displaced fractures of the
lateral end of the clavicle remains controversial. Successful results have
been reported both with primary open reduction and internal fixation and with
nonoperative treatment. The purpose of this study was to analyze the results
of employing a policy of primary nonoperative treatment of displaced lateral
fractures of the clavicle.
Methods: We treated a cohort of 127 patients who had sustained a
displaced fracture of the lateral end of the clavicle. With the exception of
seven patients who had immediate internal fixation, all of these patients were
treated nonoperatively. At the time of follow-up, nineteen patients had died
or could not be traced and fifteen were interviewed by telephone only. The
remaining eighty-six patients were assessed clinically at an average of 6.2
years after the injury. All of these patients had a functional evaluation and
were assessed radiographically.
Results: Fourteen (14%) of the 101 patients who could be contacted
had had symptoms severe enough to warrant delayed surgical intervention (Group
I). The remaining eighty-seven patients had not undergone any surgery, and
twenty-one of them (21% of the whole cohort) had a nonunion of the clavicular
fracture. The average Constant score in the nonoperatively treated group was
93 points (range, 82 to 98 points). With the numbers available, there was no
significant difference in the Constant or Short Form-36 (SF-36) scores between
the patients with nonunion (Group II) and those in whom the fracture had
healed (Group III) or between the patients who had been treated nonoperatively
(Groups II and III) and those who had had delayed surgery (Group I). There was
no significant difference between the SF-36 scores in any of the groups and
the scores for age-matched controls in the general population.
Conclusions: Nonoperative treatment of most displaced lateral
fractures of the clavicle in middle-aged and elderly patients achieves a good
medium-term functional result. Symptoms that were severe enough to warrant a
delayed reconstructive procedure developed in only 14% of the patients.
Asymptomatic nonunion does not appear to adversely affect the functional
outcome in the medium term.
Level of Evidence: Therapeutic study, Level IV (case
series [no, or historical, control group]). See Instructions to Authors for a
complete description of levels of evidence.